Availability and Feudalization of the personnel of health qualified in the country zones in Mali.

1. Availability and Feudalization of the personnel of health qualified in the country zones in Mali. Team of Mali: Mr Oumar Ibrahima Touré Dr Diakité Oumou S Maïga Dr Fodé Boundy Dr Douga Camara Dr Mama Koumaré Dr Ignace Ronse

2. Plan de présentation I. Introduction II. Objectives policy of human resources in Mali III. Attained results IV. Pressures V. Learnt lessons VI. Perspectives VII. Conclusion

3. I. Introduction The quantitative and qualitative deficit of the personnel of health constitutes a major obstacle to the access to care in developing countries. Numerous studies led about by the world, acknowledge that it is about a necessary condition for the attack of OMD in of numerous pays1. Africa is the continent which endures most crisis in human resources in health in the world. The development of Human resources in Health (RHS) is a key stake for the liking 1For instance at the level of the Worldwide Organization of Health (WHO), of the Organization West - African of Health (OOAS) and Worldwide Alliance for the Personnel of Health (AMPS).

4. I. Introduction suite SectoralPolicy adopted in 1990 blends in on the principles of care of SSP and theinitiative of Bamako. These main objectives are especially centered on: the extension of the health coverage, the research of a bigger viability and performance of the system of health (including availability of MISS and skilled personnel). The adoption of strategy of médicalisation of CSCOM by the Ministry of Health The scarceness of RH in Health competent and motivated especially at level CS

5. II.Objectives of the policy of RH in Mali General objective • Define the reference frame and major strategical orientations aiming at ameliorating allocation, management and motivation of Human resources in Health in Mali. Specific objectives: • Set up an efficient structure, which allows to assure the function of development of RH in a rational and competitive manner. • Return the personnel of health available in quality and in number being enough within the health establishments. • Assure a development harmony

6. III. Attained Results 1.Availability • 2 political choices allowing the contractualisation peripheral level (ASACO and decentralized groups) • More than 90 % of the country doctors have a contract with communities • Nowadays with the opening of private schools and break-ups of the National Institute of Training in Science of Health, the main cities count a school of training at least in health • The sitting of these schools agree better to work in their community. • Since 2000, r

7. III. Attained Results - suite With the contractualisation of structures of 1 ° contact in ASACO, the number of CSCOM is crossed from 2 to 1990 to more than 850 at the end of 2007 over envisaged 1034 (that is 82 % of realization) These associations tried hard to recruit the necessary personnel; Redeployment: This day, they consider 1SF for 24.835 hbts, 58 % of these midwifes are in Bamako while 80 % of the Malian population domicile in country zone and because of this or that benefit only little competences of one sage – woman, Measure

8. III. Results - suite 2. Fidélisation Country doctors. In Mali, for 15 years, the financial year of medicine in country middle developed in a original manner. In a country where the three quarters of the population live far from cities. Malian experience proves that the medicine of campaign is a possible alternative to attain OMD. The adoption of strategy of médicalisation of CSCOM by the Ministry of Health: Approval of realization of the small surgery List of MISS for CSCOM médica

9. III. Results Fidélisation - suite • Different Strategies of médicalisation of identified CSCOM: -Conscription of the doctor by the Associations of Community health, -Conscription of the doctor by the town hall via the fund PPTE, -Contractualisation with private Office. -Supervision inserted to ameliorate the performance of RH. • Among strategies holders: the improvement of the performance of the personnel, the motivation of the personnel, the acquisition of an expertise augmented by the supervisors which will contribute to strengthening and in

10. IV. Pressures 1. The insufficiency of RH having requested skills • The technical personnel (medical and paramedical) is deficient in quantity and in quality in the most part of the levels of the system of health, what affects availability and quality of given benefits. • Particularly, EPH and CSREF does not assure always efficiently their missions because of the insufficiency of the specialists. • Quantitative insufficiency is linked to several reasons: among whom the measurements of structural adjustment and

11. IV. Contraintes -suite 2.Institutional frame having as consequences: • the not rational planning of the needs of training; difficulties of monitoring of the career of the agents. • The absence of description of post offices and plan of career of the agents and the not application of the organic frames 3. The insufficiency of motivation of the personnel: 4. The insufficiency of the quality of the trainings of the personnel:

12. V. Learnt lessons • Elements of charm of the skilled personnel notably doctor: % on company, Degree of motivation of communities to hire a doctor for CSCOM, accommodation of the doctor, Kit of installation, Deterrent nature of the practice of the elder • Elements of fidélisation: -Community life for the doctor -Positive relations with ASACO -Positive relations with the mayor -Increase of the company of the centre -Consideration of the population -Professional plan

13. V. Learnt lessons suite • Combination of strategies favoring the fidélisation / availability: -Wage PPTE Kit of installation % company community life -Wage ASACO Kit of installation % company -Wage ASACO % company -Wage PPTE % company -Wage PPTE prevails over basic salary on company -Wage fixes ASACO • Beneficial effects of the presence of the doctor on: -the management of medicaments -Reference -The quality of care

14. VI. Perspectives Taken into account by wait of the doctors of campaign: Reinforcement of relations with the doctor leader of health Regions, stronger involvement in the activities of taking care of chronic diseases The bet with ladder of this Strategy of medicalisation Speed up the transfer of means in local authorities Accompany ASACO in management Reinforce integrated supervision Finalize and validate the strategical plan of development of RH with the partners

15. VII. Conclusion • Malian experience proves that the medicine of campaign, the contractualisation and the decentralization of Structures of health (in rays from 5 to 15 km) are possible alternatives to speed up the attack of OMD towards the skyline 2015. • If it is not reproducible in all contexts, similar experiments are under way in several countries in Africa. • It is fundamental to envisage experience more in a social logic than profitable by taking into account level of

16. VII. Conclusion- suite • The medicalisation of the country zones is an imperative of development. Our countries hard have to support this initiative of skilled conscription of the doctors / personnel everywhere in 1st line. It will succeed necessarily: -In a better quality of benefits and SSP -In a catch in load of several pathologies -In the reduction of evacuations • Moreover integrated supervision allowed, to act on the performance of RH by reinforcing skills and motivation of person

17. Thanks for your kind attention! A woman in job evacuated by cart on a distance furthermore of 5Km on lanes or of not workable roads for lack of quality personnel. This situation will last still how long?